scholarly journals Using Machine Learning to Detect Hospital-Specific Risk Factors of Surgical Site Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s452-s452
Author(s):  
Jakub Kozák ◽  
Lenka Vraná ◽  
Petra Vavřinová
Keyword(s):  
Risk Factors ◽  
Language Processing ◽  
Data Analytics ◽  
Preventive Measures ◽  
Clinical Information System ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Infection Prevention And Control ◽  
Inpatient Stay ◽  
Specific Risk

Background: Identification of healthcare-associated infections (HAIs) is just a first step in the surveillance of HAIs. The other part is the analysis and interpretation of collected data, which should help to set up effective preventive measures targeted where they are needed the most. General risk factors of HAIs are mostly well known, but how do the environment and processes of each hospital affect risks of HAI? Can advanced methods of data analytics reveal hidden hospital-specific risk factors of surgical site infections (SSIs)? Methods: We analyzed data from electronic health records stored in the clinical information system of Hospital Jihlava, Czech Republic, with 650 beds and 7,500 surgeries performed annually. For each inpatient stay with a surgical procedure, we automatically observed almost 1,500 features that could lead to a higher incidence of SSIs. These features consist of patient demographic data, information from structured data (eg, patient diagnoses, departments, specific rooms, operating theaters, surgeons and other hospital staff participating in the surgery), and information extracted from clinical notes using natural language processing (eg, procedures, invasive devices, and comorbidities). We used a model based on survival analysis to reveal the risk factors that can increase the probability of SSI during the inpatient stay or outpatient care after discharge. Results: We automatically evaluated risk factors weekly for 4 months (July 2019–October 2019). We detected 16 distinct significant risk factors during this period—between 2 and 6 active risk factors each week. For example, patients visiting a specific department were up to 5 times more likely to develop an HAI than the rest of the patients (P < .001). Some of the risk factors revealed were significant only within a short time, and some of them occurred perpetually. When a feature became significant, it was considered an early warning of a problem that should be addressed by the infection prevention and control team. Trends in risk factors coefficients can also help in assessing the performance of the launched preventive measures. Conclusions: Advanced data analytics can effectively uncover hospital-specific risk factors affecting surgical site infections. Such systems can automatically deliver results that can be further explored and used as a basis for targeted preventive measures.Funding: Datlowe provided support for this study.Disclosures: Jakub Kozák reports salary from and ownership of Datlowe.

scholarly journals Analysis of risk factors associated with caesarean section surgical site infections: a case control study

2020 ◽  
Vol 9 (12) ◽  
pp. 5075
Author(s):  
Riya Rano ◽  
Purvi K. Patel
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Subcutaneous Tissue ◽  
White Blood Cells ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Factors Associated ◽  
Operative Care ◽  
Duration Of Surgery

Background: Surgical site infection (SSI) is defined as infection occurring within 30 days after a surgical procedure and affecting either the incision or deep tissues at the operation site. SSIs are the most common nosocomial infections, accounting for 38% of hospital-acquired infections. Despite the advances in SSI control practices, SSIs remain common causes of morbidity and mortality among hospitalized patients. This study was undertaken with an objective to determine and analyze the risk factors associated with cesarean section SSIs.Methods: The study was carried out at Medical College and SSG Hospital, Baroda. After obtaining informed consent to be a part of the study, 140 subjects having cesarean section SSI as per the definition, were included as cases in the study. The controls (140) were also selected from the hospital subjects. The primary post-operative care was similar for the cases as well as controls. For patients who had SSI, samples of discharge from the cesarean section wound were collected and transported for culture. Antibiotics were given accordingly. Details about patient characteristics and outcomes were collected in the proforma for cases and controls and data analyzed.Results: The cesarean section SSI rate was 4.78%. Of the parameters studied, maternal age, parity, gestational age, HIV status, meconium stained amniotic fluid, amount of blood loss, previous surgery, duration of surgery were not associated with cesarean section SSI.Conclusions: Number of antenatal care (ANC) visits, haemoglobin, total white blood cells (WBC) count, pre eclampsia, premature rupture of membranes (PROM), non-progression in 2nd stage and subcutaneous tissue thickness were the independent significant risk factors associated with post-cesarean SSI.

Improving Quality of Surgical Care and Outcomes: Factors Impacting Surgical Site Infection after Colorectal Resection

2014 ◽  
Vol 80 (8) ◽  
pp. 759-763 ◽  
Author(s):  
Virginia Oliva Shaffer ◽  
Caitlin D. Baptiste ◽  
Yuan Liu ◽  
Jahnavi K. Srinivasan ◽  
John R. Galloway ◽  
...  
Keyword(s):  
Risk Factors ◽  
Glucose Level ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Surgical Care ◽  
Surgical Site Infections ◽  
Case Volume ◽  
Improvement Project ◽  
Combining Data

Surgical site infections (SSIs) result in patient morbidity and increased costs. The purpose of this study was to determine reasons underlying SSI to enable interventions addressing identified factors. Combining data from the American College of Surgeons National Surgical Quality Improvement Project with medical record extraction, we evaluated 365 patients who underwent colon resection from January 2009 to December 2012 at a single institution. Of the 365 patients, 84 (23%) developed SSI. On univariate analysis, significant risk factors included disseminated cancer, ileostomy, patient temperature less than 36°C for greater than 60 minutes, and higher glucose level. The median number of cases per surgeon was 36, and a case volume below the median was associated with a higher risk of SSI. On multivariate analysis, significant risks associated with SSI included disseminated cancer (odds ratio [OR], 4.31; P < .001); surgery performed by a surgeon with less than 36 cases (OR, 2.19; P = .008); higher glucose level (OR, 1.06; P 5.017); and transfusion of five units or more of blood (OR, 3.26; P 5.029). In this study we found both modifiable and unmodifiable factors associated with increased SSI. Identifying modifiable risk factors enables targeting specific areas to improve the quality of care and patient outcomes.

Mechanical failure of 113 uncemented modular revision femoral components

2020 ◽  
Vol 102-B (5) ◽  
pp. 573-579 ◽  
Author(s):  
D. R. Krueger ◽  
K-P. Guenther ◽  
M. C. Deml ◽  
C. Perka
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Femoral Component ◽  
Significant Risk ◽  
Mechanical Failure ◽  
Implant Failure ◽  
Control Group ◽  
Fracture Rate ◽  
Specific Risk ◽  
Improper Use

Aims We evaluated a large database with mechanical failure of a single uncemented modular femoral component, used in revision hip arthroplasty, as the end point and compared them to a control group treated with the same implant. Patient- and implant-specific risk factors for implant failure were analyzed. Methods All cases of a fractured uncemented modular revision femoral component from one manufacturer until April 2017 were identified and the total number of implants sold until April 2017 was used to calculate the fracture rate. The manufacturer provided data on patient demographics, time to failure, and implant details for all notified fractured devices. Patient- and implant-specific risk factors were evaluated using a logistic regression model with multiple imputations and compared to data from a previously published reference group, where no fractures had been observed. The results of a retrieval analysis of the fractured implants, performed by the manufacturer, were available for evaluation. Results There were 113 recorded cases with fracture at the modular junction, resulting in a calculated fracture rate of 0.30% (113/37,600). The fracture rate of the implant without signs of improper use was 0.11% (41/37,600). In 79% (89/113) of cases with a failed implant, either a lateralized (high offset) neck segment, an extralong head, or the combination of both were used. Logistic regression analysis revealed male sex, high body mass index (BMI), straight component design, and small neck segments were significant risk factors for failure. Investigation of the implants (76/113) showed at least one sign of improper use in 72 cases. Conclusion Implant failure at the modular junction is associated with patient- and implant-specific risk factors as well as technical errors during implantation. Whenever possible, the use of short and lateralized neck segments should be avoided with this revision system. Implantation instructions and contraindications need to be adhered to and respected. Cite this article: Bone Joint J 2020;102-B(5):573–579.

scholarly journals Risk factors for surgical site infections in neurosurgery

2019 ◽  
Vol 101 (3) ◽  
pp. 220-225 ◽  
Author(s):  
S Patel ◽  
D Thompson ◽  
S Innocent ◽  
V Narbad ◽  
R Selway ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Reoperation Rate ◽  
High Morbidity ◽  
Clinical Notes ◽  
Increased Risk ◽  
Public Data ◽  
Potential Risk Factors ◽  
Risk Patients

Introduction Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. Methods An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors. Results Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation. Conclusions This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.

scholarly journals Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty

2018 ◽  
Vol 128 (4) ◽  
pp. 1241-1249 ◽  
Author(s):  
Kingsley O. Abode-Iyamah ◽  
Hsiu-Yin Chiang ◽  
Nolan Winslow ◽  
Brian Park ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Preventive Measure ◽  
Surgical Site Infections ◽  
Smoking History ◽  
Prosthetic Implants ◽  
Increased Risk ◽  
Vancomycin Powder ◽  
First Time

OBJECTIVECraniectomy is often performed to decrease intracranial pressure following trauma and vascular injuries. The subsequent cranioplasty procedures may be complicated by surgical site infections (SSIs) due to prior trauma, foreign implants, and multiple surgeries through a common incision. Several studies have found that intrawound vancomycin powder (VP) is associated with decreased risk of SSIs after spine operations. However, no previously published study has evaluated the effectiveness of VP in cranioplasty procedures. The purpose of this study was to determine whether intrawound VP is associated with decreased risk of SSIs, to evaluate VP’s safety, and to identify risk factors for SSIs after cranioplasty among patients undergoing first-time cranioplasty.METHODSThe authors conducted a retrospective cohort study of adult patients undergoing first-time cranioplasty for indications other than infections from January 1, 2008, to July 31, 2014, at an academic health center. Data on demographics, possible risk factors for SSIs, and treatment with VP were collected from the patients’ electronic health records.RESULTSDuring the study period, 258 patients underwent first-time cranioplasties, and 15 (5.8%) of these patients acquired SSIs. Ninety-two patients (35.7%) received intrawound VP (VP group) and 166 (64.3%) did not (no-VP group). Patients in the VP group and the no-VP group were similar with respect to age, sex, smoking history, body mass index, and SSI rates (VP group 6.5%, no-VP group 5.4%, p = 0.72). Patients in the VP group were less likely than those in the no-VP group to have undergone craniectomy for tumors and were more likely to have an American Society of Anesthesiologists physical status score > 2. Intrawound VP was not associated with other postoperative complications. Risk factors for SSI from the bivariable analyses were diabetes (odds ratio [OR] 3.65, 95% CI 1.07–12.44), multiple craniotomy procedures before the cranioplasty (OR 4.39, 95% CI 1.47–13.18), prior same-side craniotomy (OR 4.73, 95% CI 1.57–14.24), and prosthetic implants (OR 4.51, 95% CI 1.40–14.59). The multivariable analysis identified prior same-side craniotomy (OR 3.37, 95% CI 1.06–10.79) and prosthetic implants (OR 3.93, 95% CI 1.15–13.40) as significant risk factors for SSIs. After adjusting for potential confounders, patients with SSIs were more likely than those without SSIs to be readmitted (OR 7.28, 95% CI 2.07–25.60).CONCLUSIONSIn this study, intrawound VP was not associated with a decreased risk of SSIs or with an increased risk of complications. Prior same-side craniotomy and prosthetic implants were risk factors for SSI after first-time cranioplasty.

scholarly journals The distribution of pelvic organ support defects in women undergoing pelvic organ prolapse surgery and compartment specific risk factors

2021 ◽  
Author(s):  
Emmanuel Payebto Zoua ◽  
Michel Boulvain ◽  
Patrick Dällenbach
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pelvic Organ Prolapse ◽  
Reconstructive Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Pelvic Organ ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Specific Risk

Abstract Introduction and hypothesis The objective of our study was to describe the distribution of pelvic organ prolapse (POP) in a population of women undergoing POP reconstructive surgery and to identify compartment-specific risk factors. Methods We conducted a retrospective observational study in a cohort of 326 women who underwent POP repair and had a standardized preoperative POP assessment using the Baden-Walker classification. The distribution of POP grade was described for each vaginal compartment. The association between the involvement of each specific compartment and predictors was evaluated with a logistic regression model. Results The frequency of significant POP (grade ≥ 2) was 79% in the anterior compartment, 49% in the middle/apical compartment and 31% in the posterior compartment. Combined significant anterior and apical defects were present in 25% of women. Increasing age was a significant risk factor for apical defect (between 60 and 70 years OR = 2.4, 95% CI 1.2–4.6; > 70 years OR = 3.4, 95% CI 1.7–6.6). Previous hysterectomy (OR = 2.2, 95% CI 1.0–4.6) was a significant risk factor for posterior defect. Conclusions In a population undergoing POP surgery, anterior compartment involvement is the most common and serious defect and can often be associated with an apical defect, especially in older women. In case of previous hysterectomy, the posterior compartment may be weakened. These findings may help surgeons to select the appropriate POP reconstructive surgery, which often should address both anterior and apical defects.

scholarly journals 844. Nosocomial Pseudomonas aeruginosa Blood-Stream Infections; Susceptibility Pattern and Mortality at a Tertiary Care Centre in Edmonton, Alberta, Canada

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S462-S463
Author(s):  
Bohdan Savaryn ◽  
Peet Van Der Walt ◽  
Stephanie Smith
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Risk Factor ◽  
Length Of Stay ◽  
Significant Risk ◽  
Blood Stream ◽  
Infection Prevention And Control ◽  
Drug Resistant ◽  
Susceptibility Pattern ◽  
Blood Stream Infections

Abstract Background Pseudomonas aeruginosa is one of the leading gram negative nosocomial pathogens, causing severe infections including blood-stream infections (BSI) with high mortality rates. (1). Multi-drug resistant P. aeruginosa (MDRPA) infection rates are reported to be increasing (2) and have been associated with increased mortality (3). This study aims to review the susceptibility pattern and trend of P. aeruginosa BSIs and mortality and identify patients at increased risk of BSI with a resistant P. aeruginosa isolate. This data has important treatment implications. Methods Cases of nosocomial P. aeruginosa bacteremia were prospectively identified at the University of Alberta, Edmonton, Alberta, Canada by the infection prevention and control surveillance program between January 1, 2007 and December 31, 2018. Patient charts were retrospectively reviewed to collect microbiological, clinical, and epidemiological information. Results 148 cases of P. aeruginosa BSI were identified over a 12-year period between January 2007 and December 2018. There were 19 cases of MDRPA BSI and 9 cases of XDRPA BSI. The incidence of P. aeruginosa BSI was 0.47 per 10,000 patient days and remained relatively stable over the study period. 66.9% of cases occurred in men. The mean age was 60 years. The average length of stay prior to bacteremia was 42 days. The overall 30-day mortality following P. aeruginosa BSI was 36.4%. Risk factors for increased 30-day mortality included: pulmonary source of infection (OR 4.26, p &lt; 0.001), bacteremia with extremely drug resistant Pseudomonas aeruginosa (XDRPA) (p &lt; 0.0001), and diabetes (OR 2.24, p &lt; 0.05). BSI with MDRPA was not an independent risk factor for increased mortality. Significant risk factors for bacteremia with an MDRPA or XDRPA were length of stay &gt; 28 days (OR 4.22, p &lt; 0.001) and hemodialysis (OR 8.92, p &lt; 0.000001). Annual hospital acquired P. aeruginosa blood-stream infections from 2007-2018 Antibiogram of P. aeruginosa blood-stream isolates from 2007-2018 Conclusion The incidence of P. aeruginosa BSI as well as the rate of MDRPA and XDRPA BSI have remained stable at our centre between 2007 and 2018. We found that BSI with XDRPA but not MDRPA alone was a significant risk factor for mortality. Risk factors for BSI with a resistant P. aeruginosa strain may be considered to guide empiric therapy. Disclosures All Authors: No reported disclosures

Risk Factors for Spinal Surgical Site Infection, Houston, Texas

2009 ◽  
Vol 30 (9) ◽  
pp. 884-889 ◽  
Author(s):  
Kelley M. Boston ◽  
Sarah Baraniuk ◽  
Shana O'Heron ◽  
Kristy O. Murray
Keyword(s):  
Risk Factors ◽  
Spinal Surgery ◽  
Povidone Iodine ◽  
Smoking Status ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Factors Associated ◽  
Surgical Duration ◽  
Study Hospital

Objective.Because of an increase in the rate of surgical site infections (SSIs) following spinal procedures at the study hospital, we conducted a study to determine risk factors associated with the development of a SSI.Design.Case-control study.Setting.A community hospital in Houston, Texas, with more than 500 beds.Patients.Fifty-five case patients who developed SSI after spinal surgery and 179 control patients who did not develop SSI after spinal surgery.Methods.We examined patient- and hospital-associated risk factors for SSI by using existing data on patients who underwent spinal operations at the study hospital between December 2003 and August 2005. Multivariable analysis was conducted using logistic regression to determine significant risk factors associated with SSI.Results.The presence of comorbidities (odds ratio [OR], 3.15 [95% confidence interval (CI), 1.20-8.26]) and surgical duration greater than the population median of 100 minutes (OR, 2.48 [95% CI, 1.12-5.49]) were identified as independent risk factors for SSI. The use of only povidone-iodine for preoperative skin antisepsis was found to be protective (OR, 0.16 [95% CI, 0.06-0.45]). Specific operating room, hospital staff involved in the procedures, workers' compensation status, method of hair removal, smoking status, or incontinence were not statistically significant.Conclusions.The presence of comorbidities and increased surgical duration are risks for postoperative infection. The use of only povidone-iodine was found to decrease the risk of infection.

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